Provider Demographics
NPI:1487949251
Name:COHEN, SAMANTHA JILL (PA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JILL
Last Name:COHEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 REMINGTON
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-5707
Mailing Address - Country:US
Mailing Address - Phone:949-857-0758
Mailing Address - Fax:
Practice Address - Street 1:17264 RED HILL AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-5628
Practice Address - Country:US
Practice Address - Phone:949-724-0011
Practice Address - Fax:949-724-0012
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14429363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical